Persons with chronic spinal cord injury (SCI) have several metabolic perturbations related to paralysis with associated immobilization and body compositional changes. The constellation of metabolic changes has many of the distinctive features of syndrome X, which is characterized by a general state of hyperinsulinemia, insulin resistance, lipid abnormalities, increased adiposity, hypertension, and cardiovascular disease. There is evidence to suggest that endogenous anabolic hormone levels are depressed in at least a subset of individuals, possibly exacerbating the adverse lipid and body compositional changes. Because of immobilization, bone is regionally osteoporotic and is continuously lost. Recognition of the potential occurrence of these metabolic sequelae and of the necessity for appropriate intervention, if available, to correct or ameliorate these abnormalities will improve clinical care in persons with SCI.